Massive Weight Loss Leg Wounds Peripheral Nerve
Abdominal Wall Surgery
Abdominal Wall Surgery addresses the following conditions:
- Wounds After Intraabdominal Surgery
- Medium and Massive Hernias
- Umbilical Hernias
- Hernias Associated with Ostomies / Parastomal Hernia
- Rectus Diastasis After Pregnancy
- Hernias After Massive Weight Loss Surgery
Dr. Dumanian also offers cosmetic abdominal surgery.
See our Frequently Asked Questions on Hernias and Abdominal Wall Surgery.
Abdominal Wall Surgery and Repair
The abdominal wall comprises the stomach muscles and the skin, and they serve to hold in the intestines, stomach, and liver. Hernias occur when there the abdominal wall muscles no longer contain the intestines, stomach, and liver. This can occur due to a natural stomach muscle weakness, such as in the groins and the umbilicus. Ventral hernias occur after a surgeon has made an incision into the abdomen, and the initial repair of the stomach muscles has not remained intact. Reasons for the development of hernias after surgery include postoperative infections, large patient size and obesity, smoking, lifting too soon after repair, and wound healing issues such as steroid use. Dr. Dumanian specializes in the repair of large ventral hernias, and has published extensively on this topic.
The abdominal wall has 3 muscles on each side of the torso, and two paired muscles that run up and down from the breast bone (the xyphoid) to the pubic bone. In the most common type of ventral hernia, the two paired up and down stomach muscles are no longer attached to each other, and move away from each other. In the separation of parts procedure, through a separate short incision, the tightest of the 3 side muscles is cut, to allow the paired stomach muscles to be brought together in the center. The side muscle that is cut is not removed, but rather is weakened. In over 200 surgeries, no one seems to notice the weakened function of that stomach muscle. Dr. Dumanian often uses a permanent mesh to reinforce the central repair. In his hands, this serves to dramatically lower the hernia recurrence rate. There are theoretic problems with the use of this mesh, including bowel adhesions, scar formation, and infections. Dr. Dumanian has not seen these problems. Not using the mesh leads to a recurrent hernia about 25% of the time. Recurrent hernias can have their own problems, including bowel adhesions and obstructions. The use of mesh to reinforce the separation of parts hernia repair is an important decision, and will be made by Dr. Dumanian at the time of surgery.
There are many types of hernias, and there are several types of hernias that Dr. Dumanian does not tend to treat. Diaphragm hernias are not visible externally. For these patients, the stomach is put back into the abdomen after it has slid into the chest. This is best done by a general surgeon. Inguinal hernias are located in the groins, and also are typically treated by general surgeons.
Additional Resources: Book Chapters by Dr. Gregory Dumanian